Clin Med
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Following successful pilots in 2006, knowledge-based assessments for those engaged in specialty training have been developed and implemented in 11 medical specialties, by the Federation of Royal Colleges of Physicians in partnership with the specialist societies. Over 400 physicians have been involved in a project that has required recruitment and training of up to 25 question writers in each discipline, and the constitution of examining boards and standard setting advisory groups in each specialty. ⋯ A total of 786 candidates sat the examination in the UK, 162 in overseas centres. Pass rates among UK trainees have generally exceeded 80%, with reliability coefficients well in excess of 0.8.
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As a consequence of change in medical, educational and regulatory practice, MRCP(UK) successfully modified the international PACES examination in 2009. This brief paper explains the rationale for change and summarises the development and implementation process.
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Biography Historical Article
King George III, bipolar disorder, porphyria and lessons for historians.
In the 1960s, Ida Macalpine and Richard Hunter, mother and son psychiatrists, stated that George III's medical records showed that he suffered from acute porphyria. In spite of well-argued criticisms by Geoffrey Dean and Charles Dent based on their extensive clinical experience of the acute porphyrias, Macalpine and Hunter were able to garnish extensive support for their claims from historians, psychiatrists, physicians and the media circus and their view is now surprisingly widely accepted. Recent research of George III's extensive medical records has shown that Macalpine and Hunter were highly selective in their reporting and interpretation of his signs and symptoms and that the diagnosis of the acute porphyria cannot be sustained. The basis for the false claims and the consequences for historians are considered and indicate that there is now an opportunity to reassess George III's contributions to events in his reign.
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The healthcare system in the UK, essentially the NHS, is an open economic system subject to the same pressures as any other economic system. The pressures concern limited resources coupled with powerful drivers for increasing spending: invention, demography and inflation. There have only ever been three types of economic system: steady state (everything, as in a feudal system, stays as it was the year before), market capitalism (supply and demand are allowed to find their own equilibrium) and some version of central planning. ⋯ A notable element of the complexity is the regulation of the introduction of new technologies. A key element of the regulatory system has been the National Institute for Health and Clinical Excellence (NICE), and a key aspect of NICE's decisions has been not just value, but also value for money. This has not been without controversy.
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Management of SAS and cardiovascular disease risk should be closely linked. It is important to screen for cardiovascular disease risk in patients with SAS and vice versa. ⋯ In the longer-term, CPAP should be used alongside standard cardiovascular risk reduction strategies including robust weight management programmes, with referral for bariatric surgery in appropriate cases. CPAP and NIV should be considered for acute admissions with decompensated cardiac failure.